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Induction of Abortion with Mifepristone (RU 486) and Oral or Vaginal Misoprostol

 Abstract Background. Medical termination of pregnancy can be successfully performed with a combination of mifepristone (RU 486) and a prostaglandin analogue. We conducted a prospective, randomized trial to compare oral with vaginal administration of the prostaglandin E1 analogue misoprostol for first-trimester abortion in women treated initially with mifepristone. Methods. The study population consisted of 270 women seeking abortion within 63 days after the onset of amenorrhea. The dose of mifepristone was 600 mg, and the dose of misoprostol was 800 mg. The study had two primary end points: expulsion of the conceptus without the need for a surgical procedure, and abortion within four hours after the administration of misoprostol.  | Vol. 332 No. 15 ORAL VS. VAGINAL MISOPROSTOL WITH RU 486 FOR FIRST-TRIMESTER ABORTION 983 INDUCTION OF ABORTION WITH MIFEPRISTONE RU 486 AND ORAL OR VAGINAL MISOPROSTOL Hazem El-Refaey M.D. Dhamnasekar Rajasekar M.B. B.Ch. Mona Abdalla Ph.D. Lynda Calder AND Allan Templeton M.D. Abstract Background. Medical termination of pregnancy can be successfully performed with a combination of mifepristone RU 486 and a prostaglandin analogue. We conducted a prospective randomized trial to compare oral with vaginal administration of the prostaglandin E1 analogue misoprostol for first-trimester abortion in women treated initially with mifepristone. Methods. The study population consisted of 270 women seeking abortion within 63 days after the onset of amenorrhea. The dose of mifepristone was 600 mg and the dose of misoprostol was 800 mg. The study had two primary end points expulsion of the conceptus without the need for a surgical procedure and abortion within four hours after the administration of misoprostol. Results. Expulsion of the conceptus without the need for a surgical procedure occurred in 95 percent of the AN estimated 30 million abortions are performed lx. worldwide each year.1 The safety of the procedure is therefore of global public health importance. Medical termination of pregnancy with a combination of mifepristone RU 486 and prostaglandin is a relatively safe and effective alternative to vacuum termination up to 63 days from the start of amenorrhea.2 The standard regimen consists of oral administration of the competitive progestin antagonist mifepristone followed 36 to 48 hours later by the administration of a prostaglandin analogue. Two prostaglandin analogues intramuscular sulprostone and vaginal gemeprost have been widely used after mifepristone. Sulprostone has been the preferred prostaglandin in continental Europe. It was recently withdrawn from the market after the occurrence of three myocardial infarctions one of which was fa-tal.3 4 In the United .